What is radiotherapy?

Radiotherapy, also known as radiation therapy, is an effective treatment for cancer. It uses radiation (high-energy beams) to kill or damage cancer cells to help prevent the cancer from growing or spreading.

Different forms of radiotherapy use different kinds of radiation, including:

• x-rays — most often used
• electron beams
• gamma rays
• proton beams

Radiotherapy is a localised cancer treatment. This means that it affects the part of your body being targeted, where the cancer is.

Radiotherapy may be given together with other treatments, such as surgery and chemotherapy.

What are the benefits of radiotherapy?

Radiotherapy uses radiation — rays of very powerful energy — to kill or damage cancer cells. Radiotherapy can be used to treat many cancers.

Like other cancer treatments, the benefits of radiotherapy may include:

• achieving remission or cure
• improving the effects of other treatments
• relieving symptoms

Radiotherapy can be used before (neoadjuvant) or after other cancer treatments (adjuvant), to make them more effective. This can help reduce the risk of your cancer coming back.

Radiotherapy can also be used palliatively — to improve comfort and quality of life. In this case, it is used to relieve pain or other cancer symptoms. It does this by making the cancer smaller or stopping it from spreading.

Chemoradiation

Chemoradiation is when both chemotherapy and radiation therapy are given together. This increases the success of the treatments, because chemotherapy makes the cancer cells more sensitive to radiation therapy.

Chemoradiation is only used to treat some types of cancer. This depends on how sensitive these cells are to radiotherapy. Cancers that can be treated include:

• brain cancer
• bowel and anal (colorectal) cancers
• head and neck cancers (such as mouth cancer and throat cancer)
• lung cancer
• cervical, uterine and vaginal cancers
• oesophageal cancer
• pancreatic cancer

Your medical team will plan your treatment to minimise damage to healthy cells near the cancer. They will carefully consider the best way to deliver your radiotherapy. You may need to have tests and scans so your oncologist can plan your radiotherapy.

What does radiotherapy involve?

Radiotherapy may be given:

• from the outside — external beam
• inside the body — brachytherapy

External beam radiotherapy (EBRT)

External beam radiotherapy is given from outside your body. The radiation beams are produced by a large machine.

Before you start treatment, you will go to a planning session. This will help your doctors work out how to position you for treatment. Depending on the area being treated, you may use:

• boards
• wedges
• a special face mask

This position needs to be set before each treatment. Your medical team will make sure you are in the right position for every treatment session before starting the machine. This helps focus the radiation specifically on the cancer and not on your healthy tissue.

Internal radiation therapy

Internal radiation therapy (brachytherapy) uses small radiation sources that are placed inside your body, close to or inside the cancer. One benefit of this treatment is that it can target a specific area — even deep inside your body — with minimal effects on healthy cells.

The devices are very small and can be inserted using a thin tube (catheter). They produce ionising radiation, a type of radiation that destroys cancer cells.

In some people, the radiation source is placed for a short time before being removed. In others, the radiation source is put in your body and left permanently.

Depending on the type of brachytherapy you are having, while the devices are inserted, you may:

• have a local anaesthetic to numb the area
• have a general anaesthetic so that you're unconscious

Brachytherapy may be used alone or together with external beam radiotherapy.

How can I prepare myself for radiotherapy?

External beam radiotherapy does not hurt. During treatment, the machine won't touch you, but you may hear some buzzing noises.

The actual radiotherapy session usually takes only a few minutes.

Depending on your situation, you may have treatment as an outpatient, meaning that you can go home between sessions.

Sessions are often scheduled once a day from Monday to Friday, with a break over the weekend. This allows your treatment to be divided into smaller sessions of radiation. You may need treatment for several weeks.

External beam radiotherapy does not make you radioactive because the radiation does not stay in your body. The permanent radioactive devices used for brachytherapy usually release only small amounts of energy, so you are not considered radioactive. Your doctor will advise you if this is different in your case.

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How soon will I recover?

The length of your treatment and how soon you recover will depend on many factors, including:

• the type and stage of your cancer
• how well the cancer responds to treatment
• how you cope with the treatment and its side effects

You may have tests or scans after finishing treatment to see how the cancer has responded. Radiotherapy continues to work for a while after treatment has finished, so you may not see the full benefits of radiotherapy for a few months.

If your radiotherapy is palliative, improvement in your symptoms is a good sign that the treatment is working.

What complications can happen?

Radiotherapy can treat many cancers but can also damage healthy cells close to the cancer cells being treated. This can lead to side effects or other complications.

The kind and severity of side effects can depend on:

• your general health
• the type and dose of radiation being given
• the part of your body being treated
• any other cancer treatments you may be having

Some people who have radiotherapy get very few side effects, while other people experience more side effects. Your side effects will in part depend on the part of your body that is having treatment.

Usually, side effects appear during or soon after treatment. Most side effects go away after treatment finishes. Sometimes radiation therapy can cause side effects months or years after treatment.

Common side effects that affect the digestive and urinary systems include:

• loss of appetite
• nausea and vomiting
• diarrhoea
• bladder issues such as urgency or incontinence

Other common side effects of radiotherapy can include:

• hair loss (alopecia)
• dry mouth and mouth sores
• cough or shortness of breath
• lymphoedema — swelling due to damage to your lymph nodes or lymph vessels
• fatigue (tiredness)
• dry, red or itchy skin — like sunburn

Many of these side effects can be treated and will improve over time.

Having radiotherapy near your reproductive organs can affect your fertility. This can be temporary or permanent. Your doctor can advise you on how to preserve your fertility.

Your medical team is very experienced in helping people who are receiving radiotherapy.

They can give you information and support to help manage any side effects or other complications.

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Are there alternatives to radiotherapy?

Alternative treatments to radiotherapy include:

• surgery
• chemotherapy
• cancer immunotherapy

Sometimes, different treatments are used at the same time. If one treatment does not work, your oncologist may recommend a different approach.

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What will happen if I decide not to have the procedure or it is delayed?

Diagnosing and starting cancer treatment as early as possible is important for improving survival rates and treatment success. It is your choice whether to delay or not have radiotherapy. Your doctor will talk to you about your options.

Resources and support

Dealing with cancer and cancer treatment can feel overwhelming, but there are many organisations that can help with information and support:

• Cancer Council or call 13 11 20 for information about cancer and cancer treatment.
• Cancer Australia for information about cancer and cancer treatment.
• My Care Plan to help you plan your future after cancer.
• Targeting Cancer by the Royal Australian and New Zealand College of Radiologists has resources for how to prepare and what to expect from your radiotherapy treatment.

To find out more about other cancer treatments, you can visit the healthdirect pages on:

• cancer treatments
• chemotherapy — strong medicines used to kill cancer cells
• cancer immunotherapy — medicines that use your own immune system to target and kill the cancer cells

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.

Languages other than English

• Cancer Council NSW provides cancer information in different languages.
• Cancer Australia has cancer resources in languages other than English.

Information for Aboriginal and/or Torres Strait Islander peoples

• Cancer Australia has resources for Aboriginal and/or Torres Strait Islander people.
• Our Mob and Cancer offers information on cancer treatments and living with cancer.